Opioid and cocaine use among primary care patients on buprenorphine—Self-report and urine drug tests

Abstract

Background: Urine drug tests (UDTs) are recommended to monitor patients treated for opioid use disorder in primary care. The aims are to (1) estimate the frequency of self-report and UDT results of opioid and cocaine use and (2) evaluate the association between treatment time with non-disclosure of opioid or cocaine use and having a positive UDT. Methods: We conducted a retrospective review of patients enrolled in a primary care-based buprenorphine program between January 2011-April 2013. We describe three clinical visits types: no disclosure of opioid/cocaine use and positive UDT; disclosure of opioid or cocaine use and a negative or positive UDT; and no disclosure of opioid or cocaine use and a negative UDT. We fit generalized estimating equations logistic regression models to evaluate whether treatment time is associated with non-disclosure of opioids or cocaine use and a positive UDT. Results: Among all UDT results (n=1,755) from 130 patients, 10% were positive for illicit opioids and 4% for cocaine. Among UDTs with illicit opioid or cocaine positive results, in 57% and 76% of these scenarios, the patient did not disclose. The odds of non-disclosure and having a positive UDT was higher in the first 180 days for opioids and 90 days for cocaine. Conclusion: Among primary care patients treated with buprenorphine, a small but substantial percentage of UDTs were cocaine or opioid positive. As treatment time increased, non-disclosure was less common but persisted even after six months. Among primary care patients treated with buprenorphine, UDTs contribute information to optimize clinical care.

Polysubstance Use Among Patients Treated With Buprenorphine From a National Urine Drug Test Database

“…This self-report bias is likely to be largest at the beginning of treatment. 17 Furthermore, given the substantial adulteration of the drug supply with fentanyl, some patients may lack awareness of the specific substances they have used.…”

“…While self-reports are often accurate, patients in some situations may not fully disclose their recent substance use histories due to social desirability bias or recall bias. This self-report bias is likely to be largest at the beginning of treatment . Furthermore, given the substantial adulteration of the drug supply with fentanyl, some patients may lack awareness of the specific substances they have used.…”

“…6,[13][14][15] Furthermore, prior studies have examined UDT findings among OUD patients treated at single sites or hospital health systems. 9,16,17 We are not aware of any studies that specifically examine national trends in definitive UDT findings among OUD patients. Definitive UDT findings can add important information to self-reported substance use from other studies because definitive UDT often provides greater specificity about types of drugs patients have been using, including drugs that they may not be aware of (eg, fentanyl adulterating cocaine or heroin).…”

“…UDT has been used to examine trends in substance use (not specific to patients treated for OUD) . Furthermore, prior studies have examined UDT findings among OUD patients treated at single sites or hospital health systems . We are not aware of any studies that specifically examine national trends in definitive UDT findings among OUD patients.…”

Reassessing the Role of Routine Urine Drug Screening in Opioid Use Disorder Treatment

“…However, the role of urine toxicology screening for patients with OUD remains controversial. While ample research demonstrates that urine toxicology tests often detect unreported substance use, there is little consensus about how to act on these results, leading to widely divergent practice patterns even within the same clinic …”